Methods and apparatus for controlling the display of medical images

ABSTRACT

A navigation rectangle controls display of medical images in a multi-display system. Multiple thumbnail sized medical images are displayed on a control panel. Each navigation rectangle encompasses one or more thumbnail size medical images on the control panel. In turn, images, corresponding to the thumbnail size medical images encompassed by the navigation rectangle, are displayed on a monitor that corresponds to the navigation rectangle. The user may fully move the navigation rectangle to select any images within an exam, and the user may resize the navigation rectangle to include or exclude images. The user may move images in and out of the navigation rectangle.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 60/422,040, filed Oct. 29, 2002, entitled “Methods andApparatus For Controlling The Display Of Medical Images.”

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is directed toward the field of medicalinformatics, and more particularly toward a medical informatics systemwith multiple displays.

2. Art Background

Radiology equipment (e.g., CT scanners, MRI scanners, X-Ray etc.) is inwide spread use as diagnostic tools in hospitals today. Typically, whencollecting information from a diagnostic tool, several medical imagesare generated for subsequent analysis and diagnosis of the patient'smedical condition. A collection of medical images that focus on aparticular area may be referred to as a “medical exam”, and a collectionof medical images or medical exams may be referred to as a “study.” Forexample, a study from an X-Ray machine may consist of a number of X-Raystaken from different perspectives of the target area. It is the totalityof the study that the physician uses to make a diagnosis of the patient.

It has become more common in the medical field for images to be stored,distributed, and viewed in digital form using computer technology.Currently, Picture Archival and Communication Systems or PACS have beenin widespread use. In a typical PACS application, image data obtained byimaging equipment such as CT scanners or MRI scanners are stored in theform of computer data files. The size of a data file for an image variesdepending on the size and resolution of the image. For example, atypical image file for a diagnostic-quality chest X-ray is on the orderof 10 megabytes (MB). The image data files are usually formatted in a“standard” or widely accepted format. In the medical field, one widelyused image format is known as DICOM. The DICOM image data files aredistributed over computer networks to specialized viewing stationscapable of converting the image data to high-resolution images on a CRTdisplay.

Radiology departments of hospitals often use computer workstations withmultiple high-resolution monitors to perform diagnostic analysis onimages. As such, it is desirable to develop a user interface for amedical informatics system that allows a user to readily control thedisplay of images on a multiple display system.

SUMMARY OF THE INVENTION

A navigation rectangle permits a user to easily control display ofmedical images in a multi-display system. Multiple thumbnail sizedmedical images are displayed on a control panel. In one embodiment,thumbnail size medical images, associated with a medical exam, aredisplayed horizontally across the control panel. Multiple monitors ordisplays are used to view the medical images. Each navigation rectangleencompasses one or more thumbnail size medical images on the controlpanel. In turn, images, corresponding to the thumbnail size medicalimages encompassed by the navigation rectangle, are displayed on amonitor that corresponds to the navigation rectangle. For example, afirst navigation rectangle may encompass images from a first medicalexam, and a second navigation rectangle may encompass images from asecond medical exam. For this example, the images from the first medicalexam are displayed on a first display, and the images from the secondmedical exam are displayed on a second display. In one embodiment, theuser may fully move the navigation rectangle to select any images withinan exam, and the user may resize the navigation rectangle to include orexclude images. The user may move images in and out of the navigationrectangle.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram illustrating one embodiment for the medicalinformatics system.

FIG. 2 illustrates an example control monitor display that shows apatient canvas view in accordance with one embodiment of the presentinvention.

FIG. 3 illustrates example diagnostic monitors corresponding to theexample navigation rectangles shown in FIG. 2.

FIG. 4 illustrates one embodiment for displaying location of an imageusing the pane icon.

FIG. 5 is a flow diagram illustrating one embodiment for the operationalflow of the software in the medical informatics system.

DETAILED DESCRIPTION

A medical informatics system provides a means to view medical images andinformation. In one embodiment, the medical informatics system is usedfor diagnostic purposes by a radiologist to view medical images. Themedical informatics system includes, in part, software for operation ona computer workstation. The computer workstations may have one or moremonitors. If the medical informatics system is used to diagnose medicalimages, the computer workstation includes high-quality monitors suitablefor viewing high-resolution images. In one embodiment, the monitorsdisplay the images and information in color.

In one embodiment, a control monitor and user input device(s) areprovided for use with the computer workstation to select medical imagesor series of medical images for viewing on the monitors. In general, thecontrol monitor displays a plurality of images/series to allow the userof the computer workstation to select specific images for display on themonitors. FIG. 1 is a block diagram illustrating one embodiment for themedical informatics system. The medical informatics system 101 includesa control panel 111 with user input device(s) and a plurality of displaymonitor (e.g., 121, 131 and 141).

In one embodiment, the control monitor displays a patient canvas view.In general, a patient canvas view permits a user to organize andnavigate images/series for selected exams. FIG. 2 illustrates an examplecontrol monitor display that shows a patient canvas view in accordancewith one embodiment of the present invention. A patient canvas viewdisplayed on the control monitor includes a plurality of exams for theselected patient.

The area beneath the Patient History Timeline 102 is the primary displayarea for the selected exams and series/images. For the example of FIG.2, three exams, arranged vertically on the screen, are shown. In oneembodiment, selected exams (115, 129 and 139) are automatically laid outchronologically from top to bottom on the patient canvas view (i.e., theexams are laid out from the newest at the top to the oldest at thebottom). In another embodiment, the exams are laid out from left toright. Each exam is broken out left to right into one or more series forCT/MR and one or more images for CD/DR. In the example of FIG. 2, thefirst or top exam 115 includes the series of images labeled Series 1,Series 2, Series 3 and Series 4. The second exam 129, displayed on thesecond rack of the patient canvas view, currently displays seven seriesof images, labeled Series 1-7. The third exam 139, displayed on thethird rack of the patient canvas view, currently displays five images.

In one embodiment, the patient canvas view is displayed in a standardorientation such that each horizontal scroll bar (e.g., scroll bar forthe middle exam) contains an exam. The user, using the horizontal scrollbar, is permitted to scroll left and right to prompt the system todisplay the series/images contained within the exam. Also, a singlevertical scroll bar (e.g., on the right of the control monitor) isprovided to permit the user to scroll, in a vertical direction (i.e.,from top to bottom), to display multiple exams.

The user may also use the features of the patient canvas view toorganize images, within an exam, by re-arranging the relative horizontalpositions among the images/series within an exam. In one embodiment,these organization operations are executed via a drag and dropoperation. In a drag and drop operation, the user “selects” aseries/image or exam with the cursor control device, and drags theseries/image or exam to the destination location. When the image islocated at the destination location, the user releases the series/imageor exam to complete the drag and drop operation. When a user drags animage to a new location and drops the image over a second image, thesystem swaps the two images on the display. For example, if the systemhorizontally displays images 1, 2, 3, 4, 5 for an exam, and the userdrops image #5 onto image #3, the system displays the images in the neworder of 1, 2, 5, 4, 3.

A user may reposition thumbnail images within a navigation rectangle inorder to reposition those images on the corresponding diagnosticmonitor. For example, if the user moves the thumbnail located in thefourth position of a navigation rectangle to the second position, thefourth thumbnail image is swapped from pane four of the diagnosticmonitor to pane two, and the second thumbnail image is swapped to thefourth pane four.

The patient canvas view on the user interface provides the functionalityto “clone” an image. To this end, a user may copy an image or series,and paste the image or series in a different location. After a session,the selection and arrangement of exams and images/series are stored in apersistent datastore. When that user selects the same patient again, thepatient canvas view is restored to the previous display from the priorsession.

Diagnostic Monitor View for Navigation and Analysis of Images:

The medical informatics system permits a user to fully “navigate” theimage. Typically, medical images are large, and cannot be displayed atfull resolution on a computer monitor. Thus, when displayed in smallwindows, only portions of the medical image are displayed at any onetime. The medical informatics system may display, in a 512×512 window,the entire source image at a lower resolution (i.e., a thumbnail sketchof the image).

The images displayed are “dynamic images.” The images are dynamicbecause the user may fully manipulate each image to display differentportions of the image (pan the original image) at different resolutions(zoom in and out). In one embodiment, a syntax provides fullfunctionality to allow the user to manipulate the image in any mannerdesired. Starting with the lower resolution “dynamic image”, the usermay zoom-in on a more specific portion of the image. Thereafter, theuser may pan the image to view a different portion of the image at thehigher resolution. Accordingly, through the pan and zoom functions, theuser may navigate through the images.

The medical informatics system permits a user to link series within thecanvas. With this feature, as a user scrolls through slices of a firstseries, the second series, linked to the first series, is also scrolled.The medical informatics system also permits linking of any image orseries, including images and series displayed in floating windows. Theuser interface also permits a user to clone a series for display atdifferent window widths and window levels (“WW/WL”) (i.e., contrast andbrightness, respectively). The user interface further permits a user toscroll a CT/MR series to a particular slice, and then link this seriesto another series for simultaneous cine. In addition, the medicalinformatics system maintains, for simultaneous cine between two series,the same anatomical position for both series, even if the seriescontains a different number of slices or different slice spacings. Forexample, a first series may contain 100 slices within an anatomicalposition of a patient, and a second series may contain only 10 sliceswithin the same anatomical position of the patient. For this example,the simultaneous cine feature displays 10 slices of the first series forevery 1 slice of the second series. WW/WL acted upon any of the threedisplay modes is inherited by subsequent display of that series or imageduring the current session. This includes larger windows created for aseries or image. Multiple link channels are supported, as indicated by anumber by a link icon and a drop down selection option at the point oflinking. For this embodiment, the user may move through a single or linkseries with a scroll wheel on a cursor control device, pan and zoomaround CR/DR images, and use the left button of the cursor controldevice to change WW/WL.

The medical informatics system synchronizes operations between thedisplay images on the diagnostic monitors and the thumbnail images onthe control monitor. For example, if user adjusts the WW/WL, the WW/WLadjustment is applied to both the display images on the diagnosticmonitors and the thumbnail images on the control monitor.

Linked images and series may also be displayed in floating windows. Inone embodiment for implementing this feature, the user double clicks ona linked image, or selects multiple series/images, to receive a displayof a collage of those series/images, each displayed as a floatingwindow. In this view, the user may cine through the series, as describedabove, linked or unlink two series, change the WW/WL with the rightmouse button, or pan and zoom with a single or linked CT/DR images.

A double-click at the floating window level or zoom box control takesthe user directly to the full screen display mode with the same imagemanipulation interactions. On a floating unlinked CT/MR series window,the user may use the scroll wheel to move the tile images back and forthone page at a time. A left-hand button on the cursor control devicepermits the user to WW/WL upon all the displayed images, so as tomaintain persistence while scrolling the pages. In one embodiment forthe nine-on-one tile mode, the size of each image within the window maycomprise 256×256 pixels. In one embodiment, floating windows have basicintelligent layout properties, in that multiple floating windows stackusing an offset of approximately 16 pixels to the right and 100 pixelsdown. As an additional feature, the floating windows have a button atthe base of the window for prior image/series and next image/seriescontrol. Also, the floating windows have a link item menu available onthe lower right corner of the image area, similar to the link button onthe canvas. This allows shared pan zoom for plain images, shared cinefor CT/MR series and shared page by page review for CT/MR series intiled mode. Additionally, the user interface permits the user to toggle,using the cursor control device and keys, functionality between pan/zoomand slice navigation for CT/MR images.

The medical informatics system may display multiple images on thediagnostic monitors. In one embodiment, the medical informatics systemdisplays images/series of images in different monitor configurations.The nomenclature used herein refers to monitor configurations in termsof “A×B”, such that “A” defines the number of windows in the horizontaldirection and “B” defines the number of windows in a vertical direction.For example, a monitor configuration of “2×3” displays two windows inthe horizontal direction and three windows in the vertical direction,for a total of six windows.

The medical informatics system may also include a multi-image mode. Forthis embodiment, the system displays multiple images within a window.For example, a window may display a CT series. For this example, theuser may desire to display, in the multi-image mode, four CT slices withthe original window that displayed the CT series.

Navigation Rectangle:

The control monitor and input device (s) permit a user to set-up andchange the layout of one or more diagnostic monitors using a navigationrectangle. The navigation rectangle allows the user to viewimages/series of an exam displayed on a diagnostic monitor. Through useof the navigation rectangle, the user selects an exam for display on adiagnostic monitor. The user is also permitted to quickly change theexam displayed on a diagnostic monitor. In addition to selecting andcontrolling the display of exams on diagnostic monitors, the navigationrectangle permits a user to select medical images/series associated withan exam. The navigation rectangle further allows the user to quicklychange those images in an exam displayed on a diagnostic monitor.

In one embodiment, each navigation rectangle is associated with a singlediagnostic monitor. FIG. 2 illustrates an example control panelincorporating the navigation rectangle of the present invention. FIG. 3illustrates example diagnostic monitors corresponding to the examplenavigation rectangles shown in FIG. 2. For the example of FIGS. 2 and 3,navigation rectangle 150 (FIG. 2) is associated with diagnostic monitor200 (FIG. 3), navigation rectangle 155 (FIG. 2) is associated withdiagnostic monitor 220 (FIG. 3), and navigation rectangle 160 (FIG. 2)is associated with diagnostic monitor 230 (FIG. 3).

The diagnostic monitors shown in FIG. 2 include multiple panes.Diagnostic monitor 200 includes two panes (one for image 114 and one forimage 116); diagnostic monitor 220 includes four panes (one for image123, one for image 124, one for image 125, and one for image 126); anddiagnostic monitor 230 includes three panes (one for image 131, one forimage 132, and one for image 134).

Diagnostic monitor 200 (FIG. 2), configured in a 2×1 monitor mode,displays the second and third series (e.g., images 114 and 116) fromexam 115 (i.e., the exam loaded on the top rack of the control monitor).As shown in FIG. 2, diagnostic monitor 220 is configured in a 2×2monitor mode. Four (4) series, series 3-series 6, from exam 129 (FIG. 2)are displayed on diagnostic monitor 220. Diagnostic monitor 230 (FIG.3), configured in a 1×3 monitor mode, displays the first three images(e.g., images 131, 132, and 134) from exam 139 (FIG. 2).

In one embodiment, the system displays images, encompassed by anavigation rectangle, on a diagnostic monitor from a left to right andtop to bottom order. For example, image 123, the left most image innavigation rectangle 155 for exam 129 (FIG. 2), is displayed ondiagnostic monitor 220 in the top right corner. The next image 124,located to the right of image 123, is displayed in the top right cornerof diagnostic monitor 220. The third image from the left, image 125, isdisplayed in the lower left corner of diagnostic monitor 220. Finally,the fourth image, image 126, encompassed by navigation rectangle 155, isdisplayed in the lower right corner of diagnostic monitor 220.

In order to distinguish the different navigation rectangles associatedwith diagnostic monitors, each navigation rectangle is displayed with aunique color. In one embodiment, colors are associated with navigationrectangles as set forth in Table 1. TABLE 1 Diagnostic Monitor NumberColor 1 Red 2 Blue 3 Green 4 Yellow

In one embodiment, a navigation rectangle only encapsulates images froma single exam. Thus, only images from a single exam are displayed on adiagnostic monitor. In another embodiment, a diagnostic monitor may bedivided into multiple “panes” when the display monitor operates in amulti-image mode. In one embodiment, to divide the navigation rectangle,the user left click drags on a thumbnail icon of the image that the userdesires to divide into a new navigation rectangle. In one embodiment,the medical informatics system permits the user to disable the functionthat splits the rectangle.

As shown in FIG. 2, the navigation rectangle is displayed on a rack fora corresponding exam. For example, navigation rectangle 155 isassociated with exam 129 displayed on the middle rack, and navigationrectangle 160 is associated with exam 139 displayed on the bottom rack.The size of the navigation rectangle is set to encapsulate thumbnailimages for those images displayed on the corresponding diagnosticmonitor. For example, navigation rectangle 155 is sized to encapsulatefour (4) series. The navigation rectangle resizes itself, as necessary,to contain the thumbnail images that are subsequently displayed on thediagnostic monitor panes.

If the diagnostic monitor configuration is such that there are morepanes than thumbnail images, the navigation rectangle displayed on thecontrol monitor encapsulates only those thumbnail images that areactually displayed on the diagnostic monitor. For example, a diagnosticmonitor configuration may comprise a 4×1 configuration, and an exam mayhave three thumbnail images. For this example, the navigation rectangleis displayed on the control monitor to encapsulate only the threethumbnail images actually displayed on the diagnostic monitor (i.e.,even though there is an empty pane in the diagnostic monitor).

The navigation rectangles are displayed on the control monitor tocontain only as many thumbnail images as may be displayed on the currentdiagnostic monitor configuration. However, the navigation rectangle isdisplayed to encompass fewer thumbnail images if displaying all thethumbnail images result in an overlap to another navigation rectangle.For example, a first navigation rectangle may start at a first thumbnailimage and may be associated with a first diagnostic monitor with a 4×1configuration. For this example, a second navigation rectangle may startat a fourth thumbnail image, within the same exam associated with thefirst navigation rectangle, and may be associated with a diagnosticmonitor that has a 1×1 monitor configuration. Although the firstdiagnostic monitor associated with the first navigation rectangle maydisplay images 1-4, the first navigation rectangle only contains images1-3 in order to avoid an overlap with the image contained within thesecond navigation rectangle. Thus, for this example, the last pane inthe first diagnostic monitor is blank. However, if the user moves thesecond navigation rectangle to another thumbnail image (e.g., the fifththumbnail image in the current exam), then the first navigationrectangle automatically places the fourth thumbnail image into the paneof the first diagnostic monitor because the overlap between the firstand second navigation rectangles no longer occur.

In one embodiment, the order of thumbnail images displayed within thenavigation rectangle follows the order of the panes for thecorresponding diagnostic monitor from a left to a right direction. Forthis embodiment, the thumbnail image displayed in the left most positionof the navigation rectangle is displayed in the first pane of thediagnostic monitor. Similarly, the thumbnail image displayed firthest tothe right in the navigation rectangle is the image with the highest panenumber on the diagnostic monitor. In another embodiment, the user mayset the layout order to display the order of images from the controlmonitor on the panes on the diagnostic monitor in either a left to rightor top to bottom order.

In one embodiment, the navigation rectangle is displayed with a thickgrab bar on the left, top, and right side of the navigation rectangle.This readily permits a user to move the navigation rectangle to capturedifferent images or a different exam. Also, the user may utilize themiddle mouse button or wheel, with the cursor control device placed overthe navigation rectangle, to move the navigation rectangle to capturedifferent images or an exam. If the user left clicks and drags the grabbar, using the cursor control device, the system permits the user tomove the navigation rectangle for placement on another exam or forplacement over a different starting thumbnail image in the same exam. Ifthe user drags a navigation rectangle, then the control monitor systemauto scrolls the shelf and the racks, as necessary. The user may dragthe navigation rectangle using the middle mouse button on a cursorcontrol device as long as the drag operation does not start in the “zoomrectangle” of a thumbnail image.

The navigation rectangles may be associated with images originating fromdifferent types of modalities, including CT, MR, CR, etc. When thenavigation rectangle is moved to another exam on a different modality,the diagnostic monitor configuration is changed based on the modality ofthe new exam. In one embodiment, the diagnostic monitor configuration ischanged, when moving the navigation rectangle between exams withdifferent modalities, as set forth below in Table 2. TABLE 2 ModalityMonitor Mode CT 1 × 1 (1 series) 2 × 1 (2 or more series) MR 2 × 3 CR 1× 1 Others 1 × 1 (1 series) 2 × 1 (2 or more series)

The navigation rectangles do not overlap thumbnail images. For example,if a thumbnail image is contained within a first navigation rectangle,that thumbnail image is not contained within another navigationrectangle. As a result, the same thumbnail image is not displayed onmore than one diagnostic monitor at a single time. The system enforcesthis rule such that the user may not position two navigation rectanglesto encapsulate the same image. If the user attempts to place a firstnavigation rectangle over images of a second navigation rectangle, thenthe first navigation rectangle is resized to encompass the images, andthe second navigation rectangle is contracted to the remaining images.For example, if the second navigation rectangle encompasses imageshorizontally arranged as images 1, 2, 3 and 4, and the first navigationrectangle is dropped on image #3, then the second navigation rectangleis resized to cover images #1 and #2, and the first navigation rectangleis resized to cover images #3 and #4.

The control system also permits a user to change the thumbnail images ofan exam displayed on a corresponding diagnostic monitor. For example, anavigation rectangle may encompass the first four of seven thumbnailimages for an exam displayed on a shelf of a control monitor. For thisexample, the diagnostic monitor may display the images in a 4×1 monitorconfiguration. If the user shuffles the fifth thumbnail image to replacethe fourth thumbnail image in the navigation rectangle, the system swapsthe fourth image with the fifth image in the fourth pane of thediagnostic monitor.

The system also permits the user to change the monitor configuration ofa navigation rectangle. However, if the user changes the monitorconfiguration of a navigation rectangle that results in an overlap withanother navigation rectangle, then the change is effectuated, but thenavigation rectangles are displayed such that they do not overlap. Thisoperation may cause blank (e.g., black) areas on the diagnosticmonitors. For example, under this scenario, the navigation rectanglethat was dragged onto the other navigation rectangle causes the systemto align the first navigation rectangle next to the second navigationrectangle and encompass those images that are available. If fewer imagesare loaded into the rack of the control monitor than the number ofmonitors, the navigation rectangle is hidden. If a navigation rectangleis hidden, it is displayed as soon as an additional image is loaded ontothe rack. For example, a new image may be loaded onto the rack byloading a new exam or by cloning an existing exam.

The navigation rectangle may be used with a diagnostic monitor dividedinto more than one diagnostic monitor. A feature allows the user to“push” navigation rectangles displayed on the control monitor. Whendragging the left-hand monitor navigation rectangle to the right side,the system presents the image that the navigation rectangle is draggedover. If the left-hand monitor navigation rectangle meets the right-handmonitor navigation rectangle and the user presses a key (e.g., F7), theleft-hand monitor navigation rectangle pushes the right-hand monitornavigation rectangle to the right. This results in the image presentedin the right-hand monitor to shift to the left-hand monitor, and the newimage is presented in the right-hand monitor. When dragging the righthand monitor navigation rectangle to the left side, the system presentsthe image that the navigation rectangle is dragged over. When theright-hand monitor reticule meets the left-hand monitor navigationrectangle and the user presses a key (e.g., F8), the right hand monitornavigation rectangle pushes the left-hand monitor navigation rectangletowards the left side. This results in shifting the image presented inthe left-hand monitor to the right-hand monitor, and a new image ispresented in the left-hand monitor.

As used herein, “current monitor”, when used in conjunction with adescription of a user interface operation, refers to the monitor thatcorresponds to a navigation rectangle identified by the user's cursorcontrol device. For example, if the user places a cursor over anavigation rectangle, then the “current monitor” is the monitor thatcorresponds to that navigation rectangle.

In one embodiment, the informatics system provides an option to “Bind toMonitor X”, wherein X identifies the monitor to the left of the currentmonitor. For this embodiment, the “Bind to Monitor X” function ispresented to the user from a right click menu. When the user invokes the“Bind to Monitor X” function, the system binds the two navigationrectangles together such that operations performed on the boundnavigation rectangles are applied across both diagnostic monitors. Inone embodiment, the system indicates that the diagnostic monitors arebound by displaying an icon on the control monitor for the boundnavigation rectangles. An “Unbind Monitors” function permits the user to“unbind” monitors, if previously bound. In one embodiment, the “UnbindMonitors” function is presented to the user from a right click menu.

In one embodiment, the informatics system displays pane icons withinimages/series encompassed by a navigation rectangle. As shown in FIG. 2,each series/image encompassed by a navigation rectangle includes a paneicon (i.e., unless the monitor is configured in a 1×1 mode). In FIG. 2,the pane icon for image 114 is labeled 165. For this embodiment, thepane icon is displayed in the upper left hand corner of the image. Inone embodiment, the pane icon is displayed with the same color as thenavigation rectangle (i.e., the color of the navigation rectanglecorresponds to a diagnostic monitor). In general, the pane iconindicates the position of the image displayed on the diagnostic monitor.

FIG. 4 illustrates one embodiment for displaying location of an imageusing the pane icon. The pane icon specifies, for each image displayedon a diagnostic monitor, a location of the image on the diagnosticmonitor. For this example, the diagnostic monitor is configured in a 2×3mode. The pane icon 310, when displayed on an image, indicates that theimage is displayed in the upper left corner pane of the correspondingdiagnostic monitor. A pane icon 320 indicates that the correspondingimage is displayed in the upper right corner pane of the diagnosticmonitor. Similarly, pane icons 330, 340, 350 and 360 show relativelocations of panes that display the images on the diagnostic monitor. Inone embodiment, the thumbnail images are displayed from left to right ona rack of the control panel. The images, corresponding to the thumbnailimages, are displayed on the panes of the diagnostic monitor startingfrom left to right and then top to bottom. For the example shown in FIG.4, the pane icons are displayed in images on the control panel in theorder shown in FIG. 4 (e.g., pane icon 310 appears in the left mostimage in the navigation rectangle, and pane icon 360 appears in theright most image in the navigation rectangle).

In one embodiment, the system permits navigation rectangle to operate in“segments.” A navigation rectangle segment manages one or morecontiguous panes in a diagnostic monitor. For example, if the diagnosticmonitor is configured in a M6P mode, a navigation rectangle segment maymanage between one and six of these panes. A single pane on a diagnosticmonitor is not managed by more than one navigational rectangle segmentunless the corresponding diagnostic monitors are bound.

A navigation rectangle segment is associated with a single diagnosticmonitor (i.e., a navigation rectangle segment does not manage panes frommore than one diagnostic monitor). A user may move a navigationrectangle segment by left click dragging the navigation rectangleborder. To move a navigation rectangle segment, the user conducts amiddle button dragging operation from a covered thumbnail window. Anavigation rectangles segment may be split into two segments by leftclick dragging from the pane icon in the thumbnail window.

In one embodiment, if the user right clicks on the border of anavigation rectangle segment, a menu is displayed. The menu provides ameans for the user to invoke the functions “Hide”, “New segment”,“Combine Segment”, “Bind Rectangles”, and “Unbind Rectangles.” The Hidefunction, when invoked, removes the navigation rectangle segment from acontrol monitor rack. If the user desires to return the navigationrectangle segment to the rack, the user conducts a left click draggingoperation using the monitor icon. The “New Segment” function, whenselected, splits that navigation rectangle segment into two navigationrectangle segments. The new segment starts at the thumbnail identifiedby the user's cursor control device. The New Segment operation is onlyeffectuated if the thumbnail, identified during the right clickoperation, is not the first thumbnail in the segment.

The “Combine Segment” function, when selected by the user, combines thecurrent segment with the segment that covers the thumbnail preceding thestarting thumbnail for the current segment. The combine segment functionis not invoked if the segment covers the first pane of a monitor.

The “Bind Rectangle” function, when selected, binds the current segmentwith the segment that covers the thumbnail preceding the startingthumbnail for the current segment. The Bind Rectangle function allowstwo segments from different diagnostic monitors to function as a singlenavigation rectangle. The Bind Rectangles function only takes effect ifthere is a segment immediately to the right of the first thumbnail ofthe current segment. The “Unbind Rectangle” function, when selected by auser, separates two previously bound navigation rectangle segments fromdifferent monitors. The “Unbind Rectangle” function separates a currentsegment from a segment that covers the thumbnail preceding the startingthumbnail for the current second.

To create a navigation rectangle segment, the user left click drags themonitor icon at the top of the control monitor screen (e.g., monitoricon 104, FIG. 2) to create a single navigation rectangle segment. Theuser may then drop the navigation rectangle segment so as to cover allpanes for that diagnostic monitor. In one embodiment, if the usercreates a single navigation rectangle segment, all navigation rectanglesegments previously associated with this diagnostic monitor aredestroyed. This feature allows the user to quickly recombine allnavigation rectangle segments into a single navigation rectanglesegment. If a navigation rectangle segment is removed, it is no longervisibly displayed in a rack on the control monitor. The user may reloadthat monitor using the monitor icon (e.g., monitor icon 104, FIG. 2).

In one embodiment, the user may set the monitor mode for a diagnosticmonitor. In one implementation for this feature, the user selects amonitor mode from a pull down menu. The pull down menu is displayed whenthe user right clicks the cursor control device when the cursor islocated over the monitor icon or the pane icon.

If the user changes the monitor mode and the new monitor mode displaysfewer panes, then the segments that encompassed the deleted panes areshortened or destroyed if no panes remain for that segment. Also, if theuser changes the monitor mode such that more panes are displayed in thenew monitor mode, then the segment, which covered the last pane in theprevious mode, is extended to cover the newly created panes. If a userplaces a navigation rectangle segment over a first thumbnail managed byanother segment, then those two segments swap positions.

A segment is displayed only for those thumbnail images currently coveredby that segment. A first segment does not overlap with another segment.In one embodiment, the segment does not display any indicator for emptypanes. This behavior is necessary to handle the following situations. Inthe first situation, there may be fewer thumbnail windows than panes ina diagnostic monitor. If the monitor is configured in a 2×3 mode andthere is a single segment for that monitor placed on an exam with onlyfour windows, then there are two empty panes and only four images fordisplay. The segment is only created for those visible thumbnails, suchthat the segment shall not be displayed for the two empty panes. In asecond situation, a first segment may cover six panes, and a secondsegment may overlap the first segment. For this example, a monitor maybe configured in a M6P mode with a single segment and a seconddiagnostic monitor may be configured in a M6P mode with a singlesegment. Under this scenario, a single exam with six thumbnails isloaded, and the first navigation rectangle starts on pane one. Thesegment for the second diagnostic monitor starts on pane number four.Although the first navigation rectangle may display six panes, thesecond navigation rectangle is managing thumbnail windows 4 to 6. Underthis scenario, the last three panes on both the diagnostic monitors areempty.

In one embodiment, the informatics system implements hanging protocols.In general, hanging protocols provide a means for the system to save thestate of displaying exams. For example, a user may display, in a firstsession, one or more exams on diagnostic monitors using the system.During the first session, the user may arrange the display of the examson the diagnostic monitors. When the user exits, the system saves thestate of the first session, such that the display location of the examson the diagnostic monitors is saved. When the user views the exams in asubsequent second session, the exams are displayed on the diagnosticmonitor in the same presentation as the first session. In addition, ifthe user specifies segments during the first session, the segments arealso presented in the second session. In one embodiment, if an exam hasnot been previously displayed, the system presents the exam (i.e.,default hanging protocol) based on 1) the modality type that acquiredthe exam; and then 2) the body part that is the subject of the exam.

In one embodiment, the system uses an exam code grouping to reference asingle hanging protocol for multiple exams. For this embodiment, one ormore exams are organized into an exam grouping, and the system assigns aunique identifier to the exam grouping. This technique minimizes storageresources on the computer by only storing hanging protocols (stateinformation) for exam code grouping.

FIG. 5 is a flow diagram illustrating one embodiment for the operationalflow of the software in the medical informatics system. The navigationrectangle(s) are selected for one or more thumbnail images of a medicalexam (block 500, FIG. 5). A user may modify the thumbnail imagesencompassed by the navigation rectangle. For example, the user maychange the thumbnail images within an exam, select more or lessthumbnail images for the navigation rectangle, or move the navigationrectangle to another exam. If the user modifies the thumbnail imageswithin a navigation rectangle, then the system displays the navigationrectangle that encompasses the new set of thumbnail images (blocks 510and 512, FIG. 5). Also, the new images, encompassed by the navigationrectangle, are displayed on the display monitors (blocks 514, FIG. 5).

If the user selects the function to bind navigation rectangles, thensubsequent operations on the bound navigation rectangles are performedas a single navigation rectangle (blocks 516 and 518, FIG. 5). If theuser displays the images on the display monitor in multiple panes, thenthe images are displayed as indicated by the display icons on thecontrol panel (blocks 520, 522 and 524, FIG. 5). If the user selects thefunction to bind segments of the panes, then subsequent operations onthe bound segments are performed as a single pane (blocks 526 and 528,FIG. 5).

Although the present invention has been described in terms of specificexemplary embodiments, it will be appreciated that various modificationsand alterations might be made by those skilled in the art withoutdeparting from the spirit and scope of the invention.

1. A method for controlling display of medical images, said methodcomprising the steps of: displaying a plurality of thumbnail sizemedical images on a control panel; displaying, on said control panel, afirst navigation rectangle that encompasses a first set of thumbnailsize medical images comprising at least one of said thumbnail sizemedical images displayed on said control monitor; displaying, on a firstdisplay, at least one medical image that corresponds to said first setof thumbnail size medical images; displaying, on said control panel, asecond navigation rectangle that encompasses a second set of thumbnailsize medical images comprising at least one of said thumbnail sizemedical images displayed on said control monitor; and displaying, on asecond display, at least one medical image that corresponds to saidsecond set of thumbnail size medical images.
 2. The method as set forthin claim 1, further comprising the steps of: displaying images for atleast one medical exam on said control panel, said images for saidmedical exam comprising a plurality of said thumbnail size medicalimages; receiving user input to select at least one thumbnail sizemedical image of a medical exam for a navigation rectangle; displaying,on said control panel, in response to said user input, a navigationrectangle that encompasses said thumbnail size medical image for saidmedical exam selected; and displaying, on a display, at least onemedical image that corresponds to said thumbnail size medical image. 3.The method as set forth in claim 2, further comprising the steps of:receiving user input to replace at least one thumbnail size medicalimage of a medical exam with at least one different thumbnail sizemedical image of said medical exam; displaying, on said control panel,in response to said user input, a new navigation rectangle thatencompasses said different thumbnail size medical image selected; anddisplaying, on a display, at least one medical image that corresponds tosaid different thumbnail size medical image.
 4. The method as set forthin claim 1, further comprising the steps of: receiving user input toselect at least one additional thumbnail size medical image; displaying,on said control panel, in response to said user input, a new navigationrectangle that encompasses said additional thumbnail size medical imageselected; and displaying, on a display, at least one medical image thatcorresponds to said additional thumbnail size medical image.
 5. Themethod as set forth in claim 1, wherein the step of displaying, on afirst display, at least one medical image that corresponds to said firstset of thumbnail size medical images comprises the step of displaying aplurality of medical images, each in a window pane on said firstdisplay.
 6. The method as set forth in claim 5, further comprising thestep of displaying, in a portion of a thumbnail image on said controlpanel, a pane icon that identifies a location of a pane for saidcorresponding medical image displayed on said display.
 7. The method asset forth in claim 1, further comprising the steps of: receiving userinput to reposition at least one thumbnail size medical image withinsaid navigation rectangle; displaying, on said control panel, inresponse to said user input, said navigation rectangle that encompassessaid repositioned thumbnail size medical image; and displaying, on adisplay, said medical images in an order that corresponds to saidrepositioned thumbnail size medical images.
 8. The method as set forthin claim 1, further comprising the steps of: generating a plurality ofvirtual monitors for a single display; displaying, on said controlpanel, a first navigation rectangle that encompasses a first set ofthumbnail size medical images comprising at least one of said thumbnailsize medical images displayed on said control monitor; displaying,within a first virtual monitor on said display, at least one medicalimage that corresponds to said first set of thumbnail size medicalimages; displaying, on said control panel, a second navigation rectanglethat encompasses a second set of thumbnail size medical imagescomprising at least one of said thumbnail size medical images displayedon said control monitor; and displaying, within a second virtual monitoron said display, at least one medical image that corresponds to saidsecond set of thumbnail size medical images.
 9. The method as set forthin claim 1, further comprising the steps of: receiving user input tobind at least two navigation rectangles; receiving user input to conductan operation on said two navigation rectangles; conducting, in responseto said input, said operation on both of said navigation rectanglesdisplayed on said control panel; and conducting said operation so as toeffectuate two monitors that correspond to said two navigationrectangles bound.
 10. The method as set forth in claim 1, furthercomprising the steps of: displaying a plurality of window panes on adisplay, such that said window panes divide said display into aplurality of sections; displaying a plurality of medical images, each ina window pane of said display; receiving user input to generate asegment for at least two window panes; receiving user input to conductan operation on said segment; conducting, in response to said input,said operation on said segment displayed on said control panel; andconducting said operation so as to effectuate said two window panes thatcorrespond to said segment.
 11. A medical informatics system comprising:control panel for displaying a plurality of thumbnail size medicalimages, for displaying a first navigation rectangle that encompasses afirst set of thumbnail size medical images comprising at least one ofsaid thumbnail size medical images displayed on said control monitor,and for displaying a second navigation rectangle that encompasses asecond set of thumbnail size medical images comprising at least one ofsaid thumbnail size medical images displayed on said control monitor;first display, coupled to said control panel, for displaying at leastone medical image that corresponds to said first set of thumbnail sizemedical images; and second display for displaying at least one medicalimage that corresponds to said second set of thumbnail size medicalimages.
 12. The medical informatics system as set forth in claim 11,further comprising input device, coupled to said control panel, forreceiving user input to select at least one thumbnail size medical imageof a medical exam for a navigation rectangle; and wherein: said controlpanel further for displaying images for at least one medical exam, saidimages for said medical exam comprising a plurality of said thumbnailsize medical images; said control panel for displaying in response tosaid user input, a navigation rectangle that encompasses said thumbnailsize medical image for said medical exam selected; and said display fordisplaying at least one medical image that corresponds to said thumbnailsize medical image.
 13. The medical informatics system as set forth inclaim 12, further comprising an input device for receiving user input toreplace at least one thumbnail size medical image of a medical exam withat least one different thumbnail size medical image of said medicalexam, and wherein: said control panel for displaying, in response tosaid user input, a new navigation rectangle that encompasses saiddifferent thumbnail size medical image selected; and said display fordisplaying, on a display, at least one medical image that corresponds tosaid different thumbnail size medical image.
 14. The medical informaticssystem as set forth in claim 10, further comprising an input device forreceiving user input to select at least one additional thumbnail sizemedical image, and wherein: said control panel for displaying, inresponse to said user input, a new navigation rectangle that encompassessaid additional thumbnail size medical image selected; and said displayfor displaying at least one medical image that corresponds to saidadditional thumbnail size medical image.
 15. The medical informaticssystem as set forth in claim 10, wherein said display for displaying aplurality of medical images, each in a window pane on said display. 16.The medical informatics system as set forth in claim 15, wherein saidcontrol panel for displaying, in a portion of a thumbnail image, a paneicon that identifies a location of a pane for said corresponding medicalimage displayed on said display.
 17. The medical informatics system asset forth in claim 10, further comprising an input device for receivinguser input to reposition at least one thumbnail size medical imagewithin said navigation rectangle; and wherein: said control panel fordisplaying, in response to said user input, said navigation rectanglethat encompasses said repositioned thumbnail size medical image; andsaid display for displaying said medical images in an order thatcorresponds to said repositioned thumbnail size medical images.
 18. Themedical informatics system as set forth in claim 10, wherein: saiddisplay further comprising a plurality of virtual monitors; said controlpanel for displaying a first navigation rectangle that encompasses afirst set of thumbnail size medical images comprising at least one ofsaid thumbnail size medical images displayed on said control panel; saidfirst virtual monitor for displaying at least one medical image thatcorresponds to said first set of thumbnail size medical images; saidcontrol panel for displaying a second navigation rectangle thatencompasses a second set of thumbnail size medical images comprising atleast one of said thumbnail size medical images displayed on saidcontrol panel; and said second virtual monitor for displaying at leastone medical image that corresponds to said second set of thumbnail sizemedical images.
 19. The medical informatics system as set forth in claim10, further comprising: input device for receiving user input to bind atleast two navigation rectangles and for receiving user input to conductan operation on said two navigation rectangles; and software forconducting, in response to said input, said operation on both of saidnavigation rectangles displayed on said control panel, and forconducting said operation so as to effectuate two monitors thatcorrespond to said two navigation rectangles bound.
 20. The medicalinformatics system as set forth in claim 10, further comprising: aplurality of window panes displayed on said display, such that saidwindow panes divide said display into a plurality of sections, eachwindow pane for displaying a medical image; input device for receivinguser input to generate a segment for at least two window panes and forreceiving user input to conduct an operation on said segment; softwarefor conducting, in response to said input, said operation on saidsegment displayed on said control panel, and for conducting saidoperation so as to effectuate said two window panes that correspond tosaid segment.
 21. A computer readable medium comprising a plurality ofinstructions, which when executed, causes the computer to perform thesteps of: displaying a plurality of thumbnail size medical images on acontrol panel; displaying, on said control panel, a first navigationrectangle that encompasses a first set of thumbnail size medical imagescomprising at least one of said thumbnail size medical images displayedon said control monitor; displaying, on a first display, at least onemedical image that corresponds to said first set of thumbnail sizemedical images; displaying, on said control panel, a second navigationrectangle that encompasses a second set of thumbnail size medical imagescomprising at least one of said thumbnail size medical images displayedon said control monitor; and displaying, on a second display, at leastone medical image that corresponds to said second set of thumbnail sizemedical images.
 22. The computer readable medium as set forth in claim21, further comprising the steps of: displaying images for at least onemedical exam on said control panel, said images for said medical examcomprising a plurality of said thumbnail size medical images; receivinguser input to select at least one thumbnail size medical image of amedical exam for a navigation rectangle; displaying, on said controlpanel, in response to said user input, a navigation rectangle thatencompasses said thumbnail size medical image for said medical examselected; and displaying, on a display, at least one medical image thatcorresponds to said thumbnail size medical image.
 23. The computerreadable medium as set forth in claim 22, further comprising the stepsof: receiving user input to replace at least one thumbnail size medicalimage of a medical exam with at least one different thumbnail sizemedical image of said medical exam; displaying, on said control panel,in response to said user input, a new navigation rectangle thatencompasses said different thumbnail size medical image selected; anddisplaying, on a display, at least one medical image that corresponds tosaid different thumbnail size medical image.
 24. The computer readablemedium as set forth in claim 21, further comprising the steps of:receiving user input to select at least one additional thumbnail sizemedical image; displaying, on said control panel, in response to saiduser input, a new navigation rectangle that encompasses said additionalthumbnail size medical image selected; and displaying, on a display, atleast one medical image that corresponds to said additional thumbnailsize medical image.
 25. The computer readable medium as set forth inclaim 21, wherein the step of displaying, on a first display, at leastone medical image that corresponds to said first set of thumbnail sizemedical images comprises the step of displaying a plurality of medicalimages, each in a window pane on said first display.
 26. The computerreadable medium as set forth in claim 25, further comprising the step ofdisplaying, in a portion of a thumbnail image on said control panel, apane icon that identifies a location of a pane for said correspondingmedical image displayed on said display.
 27. The computer readablemedium as set forth in claim 21, further comprising the steps of:receiving user input to reposition at least one thumbnail size medicalimage within said navigation rectangle; displaying, on said controlpanel, in response to said user input, said navigation rectangle thatencompasses said repositioned thumbnail size medical image; anddisplaying, on a display, said medical images in an order thatcorresponds to said repositioned thumbnail size medical images.
 28. Thecomputer readable medium as set forth in claim 21, further comprisingthe steps of: generating a plurality of virtual monitors for a singledisplay; displaying, on said control panel, a first navigation rectanglethat encompasses a first set of thumbnail size medical images comprisingat least one of said thumbnail size medical images displayed on saidcontrol monitor; displaying, within a first virtual monitor on saiddisplay, at least one medical image that corresponds to said first setof thumbnail size medical images; displaying, on said control panel, asecond navigation rectangle that encompasses a second set of thumbnailsize medical images comprising at least one of said thumbnail sizemedical images displayed on said control monitor; and displaying, withina second virtual monitor on said display, at least one medical imagethat corresponds to said second set of thumbnail size medical images.29. The computer readable medium as set forth in claim 21, furthercomprising the steps of: receiving user input to bind at least twonavigation rectangles; receiving user input to conduct an operation onsaid two navigation rectangles; conducting, in response to said input,said operation on both of said navigation rectangles displayed on saidcontrol panel; and conducting said operation so as to effectuate twomonitors that correspond to said two navigation rectangles bound. 30.The computer readable medium as set forth in claim 21, furthercomprising the steps of: displaying a plurality of window panes on adisplay, such that said window panes divide said display into aplurality of sections; displaying a plurality of medical images, each ina window pane of said display; receiving user input to generate asegment for at least two window panes; receiving user input to conductan operation on said segment; conducting, in response to said input,said operation on said segment displayed on said control panel; andconducting said operation so as to effectuate said two window panes thatcorrespond to said segment.